Provider Demographics
NPI:1033908918
Name:SHELTON, JESS A
Entity type:Individual
Prefix:MR
First Name:JESS
Middle Name:A
Last Name:SHELTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44137 BAYVIEW AVE APT 49103
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1565
Mailing Address - Country:US
Mailing Address - Phone:248-252-4493
Mailing Address - Fax:
Practice Address - Street 1:143 W SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4657
Practice Address - Country:US
Practice Address - Phone:586-697-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty